BOSTON (AP) — Hospitals, insurers, doctors and unions are spending tens of millions of dollars trying to make sure their voices are heard on Beacon Hill as Massachusetts lawmakers weigh sweeping changes to the way the state pays for health coverage.

In 2011 alone, the health care industry, one of the largest economic sectors in the state, doled out more than $11.6 million on lobbying.

And during the five years since the state passed its landmark health care overhaul, from 2007 to 2011, the total amount spent on lobbying by the industry topped $51.6 million, according to a review of state records by The Associated Press.

By contrast, the casino gambling industry spent $11.4 million on lobbying during that same stretch.

The flood of health care lobbying comes as lawmakers debate whether to create systems designed to reward health care providers for keeping patients healthy rather than paying them piecemeal for treating illnesses.

House Speaker Robert DeLeo and Senate President Therese Murray have both said they hope to deliver a payment overhaul bill to Gov. Deval Patrick this year.

This month, DeLeo said the goal of the House bill — which has not been introduced — would be to bring the annual growth in health care expenses more in line with Massachusetts’ overall economic growth rate of 3.7 percent.

Health care costs have been rising at an annual rate of 6.7 to 8 percent in recent years, said DeLeo.

“Costs are coming down, but we need a long-term sustainable plan,” said DeLeo, D-Winthrop, during a recent speech. “Health care is a $70 billion industry in Massachusetts, and we need to be more thoughtful in how these dollars are spent.”

The size of the industry and the high stakes involved in the proposed overhaul could account for the massive and sustained lobbying push.

Nine of the top 10 health care groups broke the $1 million lobbying mark during the past five years, the AP review found.

The top spender was Partners HealthCare, which spent more than $2.9 million on lobbying in that five years.

Much of that went to pay the salaries of more than a dozen lobbyists and companies working to make sure Partners’ message reached lawmakers. A smaller portion went to operating expenses.

Partners was followed by Blue Cross Blue Shield of Massachusetts and Massachusetts Association of Health Plans, both of which spent more than $2.1 million, followed by the Massachusetts Nurses Association, which spent about $2 million and Harvard Pilgrim Health Care, which spent more than $1.6 million.

Rich Copp, a spokesman for Partners HealthCare, defended the amount spent on lobbying, as did representatives for some of the other groups.

It’s critical that the health care provider keeps the lines of communication with lawmakers open as they consider new options to control the soaring costs of health care, he said.

“There’s been an intense effort in recent years to rein in health care spending,” Copp said. “We have a responsibility on behalf of our patients and employees to engage in that dialogue with government leaders on health care cost control.”

Copp said the lobbying is even more important given the reach of Partners.

The health care provider is one of the largest employers in the state, with more than 60,000 employees and nine hospitals.

Sharon Torgerson, director of public relations for Blue Cross Blue Shield of Massachusetts, said the sweeping changes to the state’s health care system required the insurer to stay involved on Beacon Hill.

“As Massachusetts’ largest health plan, we have a long and proud history of community and civic engagement,” she said. “It is important that during public policy debates we advocate to reform the way health care is delivered and paid for in order to keep it more affordable.”

Eric Linzer, a senior vice president at the Massachusetts Association of Health Plans, said the nonprofit group also wants to maintain a voice on Beacon Hill during the health care cost debate.

The group represents 13 health plans that provide coverage to more than 2.3 million Massachusetts residents.

Specifically, Linzer said in a statement that the group wants to make sure that any new laws and regulations curb what he said was the lopsided influence of better-known hospitals and other health care providers on the cost of care.

A 2010 report by Attorney General Martha Coakley found that higher-priced hospitals help drive up health costs in Massachusetts.

The report found that prices hospitals charge for the same services vary widely within the same geographic area and those changes that can’t be explained by quality of care. The report also found that higher-priced hospitals have gained more market share, forcing lower-priced hospitals to close or consolidate.

David Schildmeier, spokesman for the Massachusetts Nurses Association, said the union’s lobbying is different from the lobbying by insurers and hospitals.

Schildmeier said the union’s main concern is making sure that the welfare of nurses, staff and patients don’t get lost in the push to curb health care spending.

One bill the union has been pushing on Beacon Hill would create nurse-to-patient ratios that the union said are needed to ensure patient safety and comfort.

“Every time they try to change the payments system, they end up hurting patients,” Schildmeier said. “Our money was spent on protecting the public and protecting nurses.”

DeLeo’s speech came more than one year after Patrick unveiled a cost containment plan that sought an end to the traditional fee-for-service approach that charges patients on the basis of the tests and procedures.

Patrick’s plan called for the creation of so-called accountable care organizations and a system of payments that are tied more closely to patient outcomes.

Patrick has said that while the landmark 2006 health care bill signed by his predecessor, Republican Mitt Romney, has made health care almost universally accessible in Massachusetts, it has not made it any more affordable.

DeLeo declined to say whether the House plan would include elements of the governor’s proposal.

The HealthCare Policies In Massachusetts Are Definitely In A Crisis State. Doctors
And Hospitals Are Using Less Cost Effective Measures To please Insurers And
Bureaucrats. My Mother Was Recently Hospitalized Only after I Stood My ground .
My Mother who Is aged 81 fell and hit her head, the Emergency Room @ Carney Hospital In Dorchester, Ma , did a catscan and found swelling on her brain, still they planned to discharge her to home, I told them my mother could walk the day before ,although she can’t do it now! I am gl;ad I was adamant as six hours later
as they planned on discharging her my mother went into Cardiac and Respitatory arrest, and was transferred to the ICU for 3 days. I also asked for a Neurologist to be consulted the hospital doctors stated that they did not feel it was necessary, again I pushed the Issue and the Neurologist after examination and an EEG found my mother had seizure activity, this would have been her first seizure ever reported, My Advice Stand up for your Family, Friends, And other Relatives, My Mother would not be alive today if we let her be discharged from the ER like the hospital pushed for.

Joan, it’s just going to get worse as we go along. My cousin was discharged less than 12 hours after a full mastectomy, drain and all. Hosiptal said insurnance would not pay for ovrenight stay of even one night. She lives on her own and we had no idea this was the plan. I fought the insurance company and they still said she had to be discharged. Home with me she went and 2 days later she was back in the ER with an infection around the incision and the drain had disloged. We had been told not to change the bandage and bring her in to the doctors office for that to be done on day 3. As a result, she spend 4 days i n the hospital. Some savings and so much for patients care and rights/protections.

You are both right and kudos to you for your beliefs and standing your ground. I am middle-aged and have a long history of bowel obstructions and abdominal adhesions. The latest episode occurred in April 2011. I went to ER in Boston. When I pleaded to just have Nasal Gastric (NG) Tube treatment to allow pressure to come off of the bowel, doctors insisted I needed surgery–my third thus far. So now, I probably have more adhesions than before, and the docs admitted that they needed to remove a portion of intestines not from its being infected, but because they cut it unintentionally while operating. So now, adhesions healing inside of, not just outside of and in between, my intestines.

Docs insisted I go home before I even had my first bowel movement. Common sense alone tells you, this is something that a patient with bowel obstructions and abdominal adhesions/surgery history, should be anticipated to do before you leave the hospital post-operation, let alone all patients. But doctors insisted “they don’t worry so much anymore about post-surgery hospitalized patients voiding before leaving hospital,” and that I could always come back to ER. Don’t give me the stuff about the dangerous microbes in hospitals threatening immune systems-compromised post-operative patients. I think that having a patient just operated on for intestinal blockage should be reasonably prioritized to void, over worries concerning microbes, post-surgery and before hospital discharge. I am studying these issues on top of that–and it’s not about microbes or doctors’ post-surgery patients voiding protocol pre-discharge anymore–it’s about insurance charges, physician payments, and allowances. Always ask for a patient advocate, which I should’ve known by now to do but was too weakened physically/emotionally, on pain medication no less, to feel/remember to speak up. I may not have even needed the surgery, but docs want you in and out, like a turnstile now.

Always speak up. Yourself, or have somebody do it for you, in hospital. Surgeons should determine your operability likelihood–your PCP team and specialists, NOT the surgeons, should then be determining your discharge and home health care plans.

I don’t think that it is the docs as much as the generalized pressure to reduce ‘Length of stay” that is on everyone in the hospitals for financial reasons that is pushing this issue. Pt advocates are a good start, but getting the financial incentive out of medicine is the primary problem, and to have patient status to return to its rightful place as director medically necessary care is what we all need.

And yet with those stories we fight health care reform and allow only that to pass which does not in any way limit the control of the private insurance company. I’m all for a single payer plan. Dump the private insurance companies.

There was a time when medical care was provided based on what was needed and not by what will be paid for by a middle insurance carrier. Insurance companies should pay for medical needs and not Gym memberships, birthing classes, $15K invitro charges, etc. Why does a family of 10 pay the same premium as a family of 4? All plans should be individual plans. If you add to your family…you pay more. If you smoke…you pay more. If you have a pre existing condition…you pay more. If I have five car accidents…my insurance goes up. If I have five robberies in my home…my insurance goes up. So should medical.

Bill I never remember a time when insurance coverage was based on individual needs. If that’s the case we will have the insurance company deciding who gets what. Horrendous idea. I absolutely feel preventive medicine/practice should be rewarded. It takes very little intelligence to know it costs far less to prevent than to treat.

As the supreme court reviews the Affordable Care Act, we in Massachusetts have already had years of experience with the insurance companies pressures on our medical delivery systems. I think that we can do better for ourselves as a state, now that we see what this has played out as.
The private health insurance business is essentially like organized crime: they charge me to stay out of trouble, they raise the cost of “protection” whenever they want to, and threaten me if I don’t cooperate and continue to pay. They also use politicians through contributions and lobbying to support their business. Look for evidence that this isn’t true and you’ll come up empty handed.
My medical insurance premium was $150.00 per month three years ago. Now it is $600.00 per month. I have to have medical care, so I pay up and feel sick about it.
There is abundant research that a single financial source works better, and provides medical care that is based on human need instead of profit. We publicly contribute to share the risk and the benefits together. Lets put the strong armed muscle out of business and expand and improve medicare for all.